In Overhaul of Hospital Rules, New York Slashes Interns' Hours

Published: July 3, 1989

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Senior doctors, known as attending physicians, must be present in all of each teaching hospital's major services, or be available within 20 to 30 minutes on a 24-hour basis. Their availability is meant to enhance supervision, as well as to intervene in case of a medical emergency.

Dr. Eric Stevens, a 31-year-old chief resident who worked for three years under the former system at Presbyterian, said, ''Working so many hours, staying up all night and spending the whole next day in the hospital takes an emotional toll as well as a physical toll.'' Improved Performance Reported

Since the hospital began experimenting with the night float system last year, Dr. Stevens said, ''those of us who were assured at least four or five hours of sleep each night definitely had an improved demeanor and probably were able to work quicker, too.''

To help comply with the greater supervision requirement, Presbyterian Hospital appointed an on-site supervisor in each major service available for rapid consultation by young doctors.

''I've already consulted with the supervisor a few times,'' said Dr. Randall D. Marshall, a psychiatry intern who had just completed his first week of service at Presbyterian. ''I went to medical school at Johns Hopkins, where they really expect you to assume all of your duties on the first day. That's more than a little frightening and is frankly one of the things that attracted me about this program.''

Another young doctor, Carmel N. Fratianni, who completed her year of internship at Presbyterian last year and is beginning her residency under the new system, agreed, saying, ''It's very comforting to know that there's someone to turn to whenever there's a question about a patient whose status is deteriorating.''

Some residents say that an important bond of medical and emotional intimacy develops between doctor and patient when the doctor is able to stick with a patient from admission to the hospital through the critical turning point in the illness - when the patient either begins to improve or weaken.

Being limited to fixed shifts, these doctors say, will demean their learning experience and lead to a ''shift mentality'' and hurt patient care. Interruptions in Work Cited

''With these new rules we are constantly receiving patients who have been worked up by others and signing our own patients over to other doctors,'' said Dr. Robert D. Campagna, an intense 28-year-old in his first week at New York Hospital in Manhattan. ''I would like to be able to finish the work I begin on a patient, because the patients I work up on admission are inevitably the ones I know best.''

''I think educationally there's going to be a problem,'' said Dr. Robert F. Speira, another new intern at New York Hospital. ''When you admit a patient, it hurts not to be able to follow him for at least the initial 24 hours of care.''

''It's a very unfulfillng feeling, particuarly when you're new,'' said Dr. Sheryl Pegus, a 24-year-old resident who helps supervise new interns like Dr. Speira. ''It's tough to go home for the day when you have been on call and only get to see what another bunch of doctors did to your patients the next day. Meanwhile, when you come back on duty, you are picking up a bunch of their patients - people you've never seen before.'' Need for Support Personnel

Although they expressed concerns of their own, some senior doctors who supervise the work of both interns and residents, minimize the problems caused by interruption of care, when one doctor whose shift is ending is replaced by another.

A common refrain among the students is the lack to date of more support personnel, especially the nurses and technicicans called for in the regulations.

Although the state last month approved $65 million in reimbursement payments to hospitals to cover the cost of adding these new workers, most hospitals expect to have trouble recruiting them, given a serious shortage of most types of health-care workers.

The Hospital Association of New York State, in its pending lawsuit in State Supreme Court in Albany, has contended, among other things, that the funds provided by the state are insufficient to cover the costs of hiring the needed personnel.

In its suit, Blue Cross and Blue Shield maintains that because the Federal Government is not bound to adjust its Medicare payments to conform with changes in the state health code -changes like the 405 regulations -third-party insurers, like Blue Cross, will be forced unfairly to carry the Federal Government's share of the new costs.

Meanwhile residents wonder if they will ever see the new support personnel promised them.

''There is actually less support nowadays,'' said Dr. Daniel J. Levine, a senior resident at Presbyterian. ''If you need a cardiogram on the weekend, you have to do it yourself. If you want an IV done on a patient, same thing.''

''If we had adequate support services, the working hours of residents would become a non-issue,'' said Dr. Speira of New York Hospital. ''A good deal of our time is spent doing things that really don't require a four-year medical education.''